| NPI | 1588143960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSB94024242) |
| 103T00000X Psychologist (Licence: CA PSB94025279) | |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2025-08-26 |